Healthcare and health insurance fraud are serious issues that cost millions annually. Fraudulent activities can involve patients, healthcare providers and insurance companies in Michigan, and can take many forms.
Billing fraud
Billing fraud occurs when healthcare providers submit false or inflated bills to insurance companies for services that were not provided or were unnecessary. This fraud also occurs when providers bill for a higher level of care than was provided.
Prescription fraud
This involves the illegal distribution of prescription drugs. This can occur when doctors write prescriptions for drugs that are not needed or are used for non-medical purposes. It can also occur when patients obtain prescriptions from multiple doctors or use fake prescriptions.
False insurance claims
False insurance claims occur when individuals or healthcare providers make claims for services or treatments that were not provided. This can involve submitting fake bills or medical records to insurance companies.
Identity theft
Identity theft, as it pertains to healthcare, involves someone stealing your personal information, such as their social security number or insurance information, and using it to obtain healthcare services or prescription drugs. This can be damaging to a patient’s finances and may require lengthy litigation and the help of law enforcement to rectify.
Kickbacks
This is when healthcare providers receive payments or other incentives for referring patients to certain hospitals, clinics or providers. Kickbacks are white-collar crimes that often involve pharmaceutical companies and can lead to unnecessary or overpriced treatments and services.
Upcoding
Upcoding occurs when healthcare providers bill for more expensive procedures or services than were provided. This can result in insurance companies paying more than they should for medical care.
Unbundling
This is when healthcare providers bill separately for services that are normally bundled. This can result in insurance companies paying more for medical care than they should.
Double billing
Double billing is when healthcare providers bill both the patient and the insurance company for the same services. This is illegal and can result in providers being banned from participating in insurance programs.
Steering clear of healthcare fraud
Healthcare and health insurance fraud not only costs money but also undermines the integrity of the healthcare system. If you suspect fraud, reporting it to the appropriate authorities is important. Remaining vigilant and doing your due diligence when dealing with the healthcare system can free you from such fraud’s costly and dangerous consequences.